Books probe veiled world of medicine

Doctors take their readers behind the scenes

November 27, 2007|By Leslie Mann, Special to the Tribune

'I wanted to give readers a front-row seat, to see what's it's really like for a young person to go from med school, where you are so confident and protected, into the reality of a hospital, where you think, 'Hey, this wasn't in the textbooks!'" said Dr. Pierce Scranton of his new book, "Death on the Learning Curve."

Scranton, a Seattle-based arthroscopic surgeon, is one of many physicians who now doubles as an author. Enter "Dr." on a bookseller's Web site, and you get hundreds of titles beyond medical texts. Unlike Michael Crichton, who collected his MD but didn't practice medicine, these docs maintain their practices while writing on the side. Their books tend to fall into three categories: novels, exposes and novels that are thinly disguised exposes. Scranton calls his a "fictional memoir" with real events but changed names.

Scranton's book, which reads like a fast-paced television drama, where the camera darts from crisis to crisis, took him three years to write.

"Writing the structure of the story was easy for me," Scranton said. "But developing the characters was hard. I wouldn't have finished it if P.F. Kluge, an author and college acquaintance, hadn't told me, 'Keep going. It does not suck.'"

Scranton's message to the reader, he said, is, "Enter a teaching hospital and doctors are going to learn on you. They won't always do the right thing. Be vigilant."

Doctor-author Robin Cook's message in his latest novel, "Critical," comes through loud and clear: Specialty hospitals do money-making procedures and leave money-sucking emergency medicine to general hospitals. The Boston doctor's story pits good doc Laurie Montgomery against bad doc Angela Dawson. In the end, the good doc wins.

The novels of Dr. Martha Moody of Dayton, Ohio, include her racy "Office of Desire," which gives us a behind-the-receptionist-desk's view of a doctor's staff. Based on her book, the reader can conclude that doctors gossip about their patients, question their decisions and are not gods, for sure.

Only a doctor who also has a master's degree in fiction writing and is working on another in divinity could write the weighty fantasy novel "The Children's Hospital." Dr. Chris Adrian's characters are the only survivors of a worldwide flood, and the protagonist/doc is their Moses-like leader. Adrian, most recently a student at Harvard Divinity School, said this book came from his own 30-hour shifts, where only humor can keep you sane.

Other docs lift the veil and give it to us straight, in doses of non-fiction.

In "Complications: A Surgeon's Notes on an Imperfect Science," surgeon Atul Gawande of Boston tells us stuff we don't want to hear as we are rolled into the operating room, such as, "Even with the simplest operation, it cannot be taken for granted that a patient will come through better off -- or even better." Then he discusses the dilemma of docs having to practice on someone, yet no one wanting to be the guinea pig. "So, learning is hidden behind drapes and anesthesia and the elusions of language," he wrote.

In "Better," Gawande spills more uglies, such as the fact that 2 million Americans acquire infections each year after entering hospitals and that doctors rarely wash their hands between patients. If this makes you mad, get over it because, he wrote, patients who sue doctors rarely win.

New York City pediatrician Perri Klass wrote her chatty tell-all, "Treatment Fair and Kind: Letters to a Young Doctor," in the form of letters to her son, who wants to follow in her footsteps.

Her eclectic advice includes confessions (as a pediatrician, she dreads being asked to help people having heart attacks on planes as much as the rest of us do), trivia (most of today's young docs haven't seen chicken pox in the flesh) and politics (docs consider the new privacy laws a big pain in the gluteus maximus).

In "Final Exam: A Surgeon's Reflections on Mortality," New York surgeon Pauline Chen, who studied at Northwestern's Feinberg School of Medicine, revealed that doctors learn very little about caring for the dying or their grieving relatives. In fact, she wrote, many docs are just as uncomfortable with death as laymen are.

"By evading death," Chen wrote, "we miss one of the best opportunities for us to learn how 'to doctor,' because dealing with the dying allows us to nurture our best humanistic tendencies."

In his "How Doctors Think," Dr. Jerome Groopman wrote how docs' poor listening skills lead to wrong diagnoses.

"On average, a physician will interrupt a patient describing her symptoms within 18 seconds," wrote Groopman, who practices in Boston.

First impressions also contribute to misdiagnoses, Groopman added. Show up at a hospital unshaven, unbathed and admitting to having a drink, for example, and you may be labeled as a drunk.

Finally, Groopman wrote, beware of "diagnosis momentum." The more doctors read or hear your wrong diagnosis, he wrote, the less likely anyone will question it or explore other possibilities.